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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>无标题文档</title>
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<body>
<form id="form1" name="form1" method="post" action="">
  <p> <CENTER>申诉单</CENTER></p>
  <CENTER>
  <table width="1320" border="1">
    <tr>
      <td width="330" rowspan="2">>&nbsp;申诉人</td>
      <td width="189" height="53">姓名（必须为申诉所涉及号码机主姓名）</td>
      <td colspan="2"><label for="txt1"></label>
      <input type="text" name="txt1" id="txt1" /></td>
      <td width="199">联系电话</td>
      <td width="281"><label for="txt2"></label>
      <input type="text" name="txt2" id="txt2" /></td>
    </tr>
    <tr>
      <td height="40">电子邮箱</td>
      <td  colspan="2"><label for="txt3"></label>
      <input type="text" name="txt3" id="txt3" /></td>
      <td width="199">邮政编码</td>
      <td><label for="txt4"></label>
      <input type="text" name="txt4" id="txt4" /></td>
    </tr>
    <tr>
      <td  rowspan="2">被申诉人</td>
      <td>企业名称</td>
      <td colspan="4"><select name="xuan1" id="xuan1">
        <option>福州市</option>
      </select>
        <label for="xuan2"></label>
        <select name="xuan2" id="xuan2">
          <option>鼓楼区</option>
        </select>
        <label for="xuan3"></label>
        <select name="xuan3" id="xuan3">
          <option>电信</option>
      </select></td>
    </tr>
    <tr>
      <td height="45">通信地址</td>
      <td colspan="4"><label for="txt5"></label>
      <input type="text" name="txt5" id="txt5" size="100"/></td>
    </tr>
    <tr>
      <td>是否就申诉事项向被申诉人提出投诉</td>
      <td colspan="7"><label for="xuan1">
        <input type="radio" name="radio" id="danxuan1" value="danxuan1" />
        是 
        <input type="radio" name="radio" id="duanxuan2" value="duanxuan2" />
      否</label></td>
    </tr>
    <tr>
      <td>被申诉人是否给予处理或回复</td>
      <td colspan="7"><input type="radio" name="radio" id="danxuan2" value="danxuan1" />
是
  <input type="radio" name="radio" id="duanxuan" value="duanxuan2" />
否</td>
    </tr>
    <tr>
      <td  rowspan="3">申诉内容</td>
      <td height="96" >申诉要求</td>
      <td  colspan="4" ><label for="wenbenyu1"></label>
      <textarea name="wenbenyu1" id="wenbenyu1" cols="45" rows="5">详见附件用户申诉信</textarea></td>
    </tr>
    <tr>
      <td height="87">申诉事实与理由</td>
      <td  colspan="4" ><textarea name="wenbenyu2" id="wenbenyu2" cols="45" rows="5">详见附件用户申诉信</textarea></td> 
    </tr>
    <tr>
      <td height="109">申诉依据</td>
      <td colspan="4"><textarea name="wenbenyu3" id="wenbenyu3" cols="45" rows="5">详见附件用户申诉信</textarea></td>
    </tr>
    <tr>
      <td height="54">申诉来源</td>
      <td colspan="7"><label for="xuan4"></label>
        <select name="xuan4" id="xuan4">
          <option>传真</option>
      </select></td>
    </tr>
    <tr>
      <td height="92">附件上传</td>
      <td colspan="7"><label for="txt8"></label>
      <input type="text" name="txt8" id="txt8" />
      <input type="submit" name="button1" id="button1" value="浏览" />
      <input type="submit" name="button2" id="button2" value="添加附件" /></td>
    </tr>
  </table></CENTER><center>
  <p>
    <input type="submit" name="提交" id="提交" value="提交" />
  </p></center>
</form>
</body>
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